Vocabulary Place of Service belongs to the domain Place of Service and is used to populate place_of_service_concept_id in the care_site table.

Vocabulary Visit belongs to the domain Visit and is used to populate Visit_concept_id.

Vocabulary Place of Service is mapped to Visit in both concept_relationship and concept_ancestor table (I dont know how complete this is @Dymshyts ?) Place of Service is a child of Visit

There is a n:1 relationship between visit_occurrence table and care_site table - so there may not be more than one care_site_id per visit_occurrence_id record. As an extension, there may not be more than one place_of_service_concept_id per visit_occurrence_id.

Would it then be reasonable to add all the concept's in Place of Service vocabulary from Place of Service domain into Visit domain, as a standard_concept and maintain hierarchical relationship?

I wanted to ask - of the 59 standard and about 487 total concept's in the Place of Service domain, can we change their domain to visit - so that they may be used in the visit_occurrence table as either visit_concept_id and visit_source_concept_id?

The classification of visit's into inpatient and outpatient is then natural using the concept ancestor table

I am currently working with encounter data that contains scenarios like the following – A patient had a series of micro visits/encounters during a major encounter/visit_occurrence on a particular day. During this visit, the patient after seeing his/her PCP at the out-patient clinic had subsequent encounters at Cardiology (care site?/place of service?), Endocrinology(care site?/place of service?) and ER where he was admitted for observation. All these encounters occurred at the same facility/location for example, Emory Hospital on Emory University campus Atlanta, Ga. How will this scenario be represented in the CDM within the ontology described below? Any help will be greatly appreciated.

You got 5 Visits: three (i) outpatient Visits at the PCP, the Cardiology Outpatient Department and the Endocrinology Outpatient Department, the (ii) ER Visit, where the patient was sent to the (iii) hospital Visit for the observation (not sure that is a hospital visit, some institution don't count the observation visits as such). The Case Site for these are all Emory Hospital Atlanta.

You got non or one Visit Detail: The observation hospitalization, with the specific Department at Emory Hospital, where the observation took place as Care Site.

Note: Outpatient and ER Visits are usually simple: The patient is in and out of these. Not much happens inside. In your case, there is a lot of outpatient activity and the funny ill-defined observation visit. This is not typical. Usually, the patient feels sick, goes to the doctor, who quickly decides that the situation requires rapid action and refers the patient into the ER. From there, the patient takes some career through the various hospital departments, for which is why we have the Visit Details.

@kDarko, if it helps: The fields in care_site that are analytically useful are the location_id (because we could use lat and long) and place_of_service_concept_id (because it has concept_id's); rest of the fields in that table are not standardized and pretty much not useful for standardized analytics.

PCP at the out-patient clinic had subsequent encounters at Cardiology (care site?/place of service?), Endocrinology(care site?/place of service?)

You can use the care_site_id and care_site_name field in the care_site table to represent the PCP, Cardiology, and Endocrinology. All will have the same place_of_service_id to represent Emory hospital. And most likely the same location_id, but it could be different depending on the granularity of your address/location data. Care_site_id is:

Gowtham_Rao:

not useful for standardized analytics.

but it may be useful for your internal purposes. If it isn't, not sure you want to create a bunch of care_site_ids (and extra work) for your data.

Yes, if we change the field name from place_of_service_concept_id to caresite_source_concept_id and caresite_concept_id. This is obviously not backwards compatible, but will be consistent with Omop CDM conventions. Maybe done for CDM 6.x

@christian_reich , why did place_of_service_concept_id break out of the visit table into care_site table when we moved from CDM 4 to 5?

For an ambulatory surgery, how would one code the visit and care site?

Is ambulatory surgery, an 1. Attribute of the physical place where care is provided. 2. Attribute of the business/administrative entity for billing or documentation purpose i.e. the same physical entity can take on many place_of_service.3. Attribute of the (service) visit like a condition, procedure is an attribute of a visit.